title: Academic performance in adolescence after inguinal hernia repair in infancy: a nationwide cohort study.
abstract: BACKGROUND
  Although animal studies have indicated that general anesthetics may result in widespread apoptotic neurodegeneration and neurocognitive impairment in the developing brain, results from human studies are scarce. We investigated the association between exposure to surgery and anesthesia for inguinal hernia repair in infancy and subsequent academic performance.
  
  
  METHODS
  Using Danish birth cohorts from 1986-1990, we compared the academic performance of all children who had undergone inguinal hernia repair in infancy to a randomly selected, age-matched 5% population sample. Primary analysis compared average test scores at ninth grade adjusting for sex, birth weight, and paternal and maternal age and education. Secondary analysis compared the proportions of children not attaining test scores between the two groups.
  
  
  RESULTS
  From 1986-1990 in Denmark, 2,689 children underwent inguinal hernia repair in infancy. A randomly selected, age-matched 5% population sample consists of 14,575 individuals. Although the exposure group performed worse than the control group (average score 0.26 lower; 95% CI, 0.21-0.31), after adjusting for known confounders, no statistically significant difference (-0.04; 95% CI, -0.09 to 0.01) between the exposure and control groups could be demonstrated. However, the odds ratio for test score nonattainment associated with inguinal hernia repair was 1.18 (95% CI, 1.04-1.35). Excluding from analyses children with other congenital malformations, the difference in mean test scores remained nearly unchanged (0.05; 95% CI, 0.00-0.11). In addition, the increased proportion of test score nonattainment within the exposure group was attenuated (odds ratio = 1.13; 95% CI, 0.98-1.31).
  
  
  CONCLUSIONS
  In the ethnically and socioeconomically homogeneous Danish population, we found no evidence that a single, relatively brief anesthetic exposure in connection with hernia repair in infancy reduced academic performance at age 15 or 16 yr after adjusting for known confounding factors. However, the higher test score nonattainment rate among the hernia group could suggest that a subgroup of these children are developmentally disadvantaged compared with the background population.
authors.affiliation: Department of Anesthesia and Intensive Care, Odense University Hospital, Denmark. tomghansen@dadlnet.dk
authors.forename: Tom G
authors.initials: TG
authors.lastname: Hansen
authors.forename: Jacob K
authors.initials: JK
authors.lastname: Pedersen
authors.forename: Steen W
authors.initials: SW
authors.lastname: Henneberg
authors.forename: Dorthe A
authors.initials: DA
authors.lastname: Pedersen
authors.forename: Jeffrey C
authors.initials: JC
authors.lastname: Murray
authors.forename: Neil S
authors.initials: NS
authors.lastname: Morton
authors.forename: Kaare
authors.initials: K
authors.lastname: Christensen
mesh_terms: D000124:Achievement; D000293:Adolescent; D000758:Anesthesia / Q000009:adverse effects / Q000706:statistics & numerical data*; D015984:Causality; D003072:Cognition Disorders / Q000453:epidemiology / Q000209:etiology; D015331:Cohort Studies; D015897:Comorbidity; D003718:Denmark / Q000453:epidemiology; D004522:Educational Status; D005260:Female; D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D016017:Odds Ratio; D013514:Surgical Procedures, Operative / Q000009:adverse effects / Q000706:statistics & numerical data*